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Gemma Hardy Post Traumatic Amnesia
Gemma Hardy Post Traumatic Amnesia
Gemma Hardy
Clinical Psychologist
Neuropsychology Department,
Addenbrookes Hospital
gemma.hardy@addenbrookes.nhs.uk
Outline
Overview
Symptoms
Assessment
Rehabilitation
Management
Case study
PTA
Confusional state of clouded consciousness
following TBI
Present in 70% patients
Duration
Injury
5 60
minutes
Mild
1 24 hours
Moderate
1 7 days
Severe
1 4 weeks
Very severe
> 4 weeks
Extremely
severe
PTA
Amnesia
Impaired attention
Anterograde
No ability to form
day-to-day
memories
Retrograde
Loss of memory for
events prior to TBI
Disorientation
Time
Place
Person
Behavioural
change
Agitation
Disinhibition
Emotional lability
Childlike persona
Wandering
Fatigue
Confabulation
PTA
Impaired attention
Poor concentration
Highly distractible
Impaired awareness
PTA Assessment
Determine duration of PTA
Standardised measures
GOAT (Galveston Orientation and
Amnesia Test)
10 items
Orientation (person, time, place)
Recall for events (anterograde and retrograde)
Score 0 100
Consecutive scores > 75 = end of PTA
PTA Assessment
However
Qualitative features absent on testing
Cant account for fluctuation
Difficult to distinguish from chronic memory
impairment
Informal assessment
Obvious change to awareness and orientation
(Russell & Smith, 1961)
Continuous day-to-day memory
Sustained attention
Orientation to season, surroundings, visitors
OR plateau to cognitive improvement in cases of
severe long-term impairment
PTA recovery
Gradual
Currently determined by PTA test
performance
However
Many qualitative features absent on
testing
Difficult to distinguish from chronic
memory impairment
Person
Recognition memory
Place
Time
PTA Research
Research project within department
Service development
Developed CAM-PTA (Cristina BlancoDuque from MRC-CBU and the team
from MTC)
Evaluate use by correlating against
current tools and MDT opinion
PTA Rehabilitation
Can be problematic given memory
difficulties
Difficult to learn facts but can acquire
procedural knowledge
Reality orientation programmes can be efective
PTA Rehabilitation
Psychological approaches to
managing challenging behaviours
Verbal / non-verbal de-escalation
Goal Setting
Assessment (e.g. ABC analysis)
Tailored Intervention (Environmental
modification, Behavioural Reward
program
PTA Management
Keep in mind they have memory and
attention difficulties!
Give information in short sentences and
repeat
Always tell patient what you are doing and
why you are doing it
Avoid over-fatigue (allow for breaks, keep
visitors to minimum)
Think of environment (over or under
stimulated?)
PTA Management
Be prepared for challenging behaviours
Discuss specific behaviours in MDT
meetings
Check behavioural guidelines in notes
Approach Clinical Psychologist for support
PTA Management
Minimise frustrations and aggravations
Provide reassurance wherever possible, as
many times as possible
Dont ask patient to do more than one thing
at a time
Keep noise / other stimulation to a minimum
(where possible)
Key References
Ahmed, S., Bierley, R., Sheikh, J.I., & Date, E.S. (2000). Posttraumatic amnesia after closed head injury: a review of the
literature and some suggestions for further research. Brain Injury,
14, 9, 765-780.
Thomas, H., Feyz, M., LeBlanc, J., Brosseau, J., Champoux, M.C.,
Christopher, A., et al. (2003). North star project: reality orientation
in an acute care setting for patients with traumatic brain injuries.
The Journal of Head Trauma Rehabilitation, 18, 292-302.